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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603183
Report Date: 04/02/2026
Date Signed: 04/02/2026 01:49:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2026 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20260325103229
FACILITY NAME:COUNTRY VIEW ASSISTED LIVINGFACILITY NUMBER:
198603183
ADMINISTRATOR:DENNISE TORRESFACILITY TYPE:
740
ADDRESS:824 W. CAMERON AVETELEPHONE:
(626) 962-3511
CITY:W. COVINASTATE: CAZIP CODE:
91790
CAPACITY:136CENSUS: 111DATE:
04/02/2026
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Claudia CordobaTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Staff did not distribute resident's medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Claudia Cordoba. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained.

The investigation consisted of the following: LPA obtained a copy of the resident and staff rosters, interviewed Resident 1 (R1) through Resident 11 (R11), interviewed Administrator, Staff 1 (S1) and Staff 2 (S2), LPA conducted tour of medication room, reviewed Residents Medication Administration Records (MARs). R1’s file reviewed and relevant documentation were obtained including copies of MAR for the months of March and April 2026.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20260325103229
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: COUNTRY VIEW ASSISTED LIVING
FACILITY NUMBER: 198603183
VISIT DATE: 04/02/2026
NARRATIVE
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Investigation revealed the following: Regarding allegation, Staff did not distribute resident's medication as prescribed, it was alleged that on 3/20/2026 staff distributed the wrong medication (pill) to R1 and that afterwards resident had a reaction.

interviewed Administrator and staff denied the allegation. They stated that they provide residents with their medications as prescribed. They stated no medication error or medication reaction reported for R1 or other residents and there is no history or documentation that there was a reaction for any residents. Interviewed staff stated that it is essential to follow the established safety protocol to ensure each resident receive the correct medication. They stated they carefully check medication labels with the resident's MAR and document immediately after giving the medication. Interviewed Administrator and staff indicated that facility utilized QuickMar program for medication management which requires staff to select the medication pass time and the specific resident and displays the resident's photo along with only medications scheduled for that time, ensuring accurate administration. Resident interviews revealed that staff provide them with their prescribed medications daily on a timely manner. Interviewed residents stated that the staff didn't provide them with the wrong medication and indicated they have not had any issues/concerns regarding this matter. Interviewed residents indicated they have never had any reaction from the medications and have not heard other residents complaining about their medication not being administered as prescribed by the doctor and because of that they had a reaction. LPA reviewed five random residents Medication Administration Records (MAR) including R1's for the months of March and April 2026 and observed that their medications including PRNs to be documented properly and given as prescribed. Records reviewed did not show any past or current issues regarding medication being given out to the residents incorrectly. Documentation reviewed and interviews conducted with staff and residents do not corroborate this allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated

Exit interview conducted and a copy of this report was provided to Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2